About this survey:

The Northern Sierra Opioid Safety Coalition is conducting a survey on community health and health behaviors in Plumas, Modoc, Sierra, Lassen, and Siskiyou counties. As an adult who lives in one of those counties, you are being invited to complete the survey.

If you choose to participate, please complete the following survey. This survey will take no more than 15 minutes to complete. The knowledge gained from this survey may help local agencies understand the health needs of our community and adapt the services provided to meet those needs.

All of the answers that you provide are completely anonymous. You are free to withdraw your consent, skip any questions, and/or discontinue your participation in this survey at any time. Thank you for your help!

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1.Which county do you live in?

Sierra

Lassen

Plumas

Modoc

Siskiyou

Other (please specify)

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2.In general, how would you rate your overall health?

Excellent

Very good

Good

Fair

Poor

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3.Is there a place that you usually go when you are sick or need advice about your health?